Surgery resident LOS project streamlines communication between care teams, improves discharge processes

headshot of Erik Anderson in a white coat
Erik Anderson, MD, MS

Patients want to go home, and the best doctors get them there: quickly, efficiently, and without compromising the level of care they need.

For many health care institutions, length of stay (LOS) is an important quality metric whose impact affects everything from bedspace to medical resources. One way of optimizing this is streamlining patient discharge, where information between rotating care teams can suffer from gaps in communication.

Now, a simple sheet of paper is filling in the cracks.

“We call it the discharge sheet, and residents fill it out on morning rounds,” said Erik Anderson, M.D., a resident in the UF Department of Surgery who planned the project. “The goal was to facilitate discharge planning for all floor patients and communication between different members of the care team—including physicians, nurses, case management, etc.”

As a housestaff representative on the quality and patient safety committee at UF Health, Anderson looked for a small-scale improvement that could be easily implemented but have far-reaching effects on the quality of care he provided to patients on a day-to-day basis.

The discharge sheet offered options for day and time of intended discharge (today AM, today PM, tomorrow, two days from now, medically cleared but awaiting placement at a long-term care facility), and helped prompt providers to begin planning for discharge. Previously, Anderson said, discharge planning was something that happened on the fly or along the way, without an established process for care coordination between members of the team.

After doing some research, he noted different processes for effective patient discharge at other hospitals, and decided to implement his own.

“Length of stay is especially important when we’re in the midst of a pandemic,” Anderson pointed out. “If we stay on top of it, we can get the patients out as soon as is appropriate, clean and open up the rooms, decreasing the wait time for people who need the space and the care.”

Toward the project’s end, EPIC implemented a digital version of the discharge sheet, documenting discharge milestones to facilitate discharge processing and planning, Anderson said.

“It was almost like a natural transition between our discharge sheet and something more robust in the system,” he recalled.

Length of stay is just one of the quality goals the department intends to focus on. Going forward, Anderson believes there’s an opportunity to position quality initiatives as integral to not only the caliber of treatment that patients receive, but to their perception of it.

“It enhances the patient experience and shows that we care about how we care for them, Anderson said. “And their family sees that, too. It improves all aspects of treatment, not just the optimization.”